Basic Information
Provider Information
NPI: 1053870733
EntityType: 2
ReplacementNPI:  
OrganizationName: SOLSTICE MENTAL HEALTH & WELLNESS
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 4005 SPICEWOOD SPRINGS RD STE B401
Address2:  
City: AUSTIN
State: TX
PostalCode: 787598680
CountryCode: US
TelephoneNumber: 5122994024
FaxNumber:  
Practice Location
Address1: 4005 SPICEWOOD SPRINGS RD STE B401
Address2:  
City: AUSTIN
State: TX
PostalCode: 787598680
CountryCode: US
TelephoneNumber: 5122994024
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/13/2019
LastUpdateDate: 06/11/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LENKER
AuthorizedOfficialFirstName: MONICA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 5122994024
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: LCSW
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QM0801X  Y Ambulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)

No ID Information.


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